Kontogiannis, S, Mohammed, O, Natsos, A, Drettas, P

Penile Prosthesis, Priapism, Erectile Dysfunction, Cavernotomes

One of the most difficult challenges in prosthetic urology is the insertion of penile implants into corpora scarred from an episode of priapism. In this video, we show such a case of penile prosthesis after an episode of ischemic priapism. Priapism is defined as a penile erection lasting more than 4 hours unrelated to sexual interest or stimulation [1]. It can be classified into ischemic, arterial or stuttering [2]. Ischemic priapism is a compartment syndrome inside the two cavernosal bodies and it leads to severe pain. This ischemic state can cause cavernosal artery thrombosis and corporeal fibrosis. With extensive corporeal fibrosis, a penile implant is the only viable option to alleviate sexual dysfunction [3,4]. In cases of scarred penile cavernosal bodies, surgery becomes challenging even for experienced surgeons, as it can be very difficult to dilate the corpora [5,6,7]. Usually, initial insertion of a malleable device as temporary measure, helps to maintain the penile length and simplify the insertion of an inflatable device [8]. In this case, we dilated the corpora cavernosa initially with Metzenbaum scissors in a very thorough and careful way. We placed the tip of the scissors at the outer side of each cavernous body (away from the urethra) and we advanced it to the tip of corpus cavernosum. Then, we used the cavernotomes. The cavernotomes feature bayonet handles and wood rasp surfaces with backward cutting teeth [9]. We advanced them in an oscillating fashion and a tunnel was created in the fibrotic tissue. Then, by withdrawing them, we utilized their backward cutting teeth to “drill” a space [10]. Interestingly, as shown in the video, the initial proximal left dilation was uneven. So, we dilated again the left side with a cavernotome and then, we further dilated with Brooks dilators. Finally, we put the penile prosthesis in place.

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